By Deborah Jeanne Sergeant
Approximately 795,000 Americans experience a stroke each year, including 610,000 first-time strokes and 185,000 recurrent strokes. Of these patients, 39 out of every 100,000 die. Survivors often face a wide range of outcomes and challenges during recovery.
“It depends on the severity of the stroke and location,” said Angelina Wronski, registered nurse and stroke coordinator and educator for Unity Hospital. “Not all strokes are created equal.”
Some people notice no deficits; others may see varying levels of recovery for around a year afterwards. Wronski said that post-stroke fatigue can make recovery hard as patients try to keep up with occupational therapy, physical therapy and speech therapy.
Many patients undergo in-patient rehabilitation at a hospital or long-term care facility, which Wronski calls intermediate steps for patients who may have a more severe disability. They may have in-home therapies as well to ensure they can perform activities of daily living (ADLs).
Wronski encourages caregivers to allow patients time to begin their morning routine and ADLs, as for a while at least, these may take much longer. Performing everything for the patient may reduce their ability to perform these tasks independently later.
It’s also helpful for caregivers to support patients in controlling chronic health conditions like hypertension, along with their neurology visits.
“Keeping up with those doctor’s visits is important,” Wronski said.
A newer therapy for stroke patients is the vagus nerve stimulator. Wronski said that this can help stroke patients with chronic deficits in their upper extremity.
“People can regain the ability to write and hold their grandchildren,” she said. “It’s placed in the upper chest under the muscle. They swipe the magnet and it stimulates the nerve. It connects the signal that was once broken.”
The implant is used in conjunction with physical therapy.
Katherine Kiehle, stroke navigator and nurse and performance improvement coordinator at Highland Hospital, said that stroke recovery has to do with neural plasticity, “your brain’s ability to relearn things,” she said. “I think that most people will agree that the best way to recover after a stroke is to adhere to your rehab plan which is difficult if you’re struggling with motivation. Many have post-stroke depression.”
Highland offers a post-stroke platform for people discharged to home to help them engage in daily practices as part of rehab.
“It puts a lot of empowerment on the patient to focus on their own care,” Kiehle said.
She added that exposure to language can help patients recover their power of speech.
Stroke patients and providers form a recovery plan including medication, managing comorbidities and overall goals for their recovery. During this discussion, “it’s always important to ask questions,” Kiehle said. “I highly recommend that people write down their questions.”
It also helps to have a friend or family member attend appointment. It helps to ask, “’What is my main problem, what do I need to do and why is it important for me to do that?’” Kiehle said.
Another aspect of stroke recovery is gaining moral support. Nurse Alice Taylor, quality assurance stroke—sepsis—STEMI coordinator for Thompson Health, recommends joining a stroke support group.
“Staying positive and learning to believe that slow progress is still progress are two key recovery recommendations I’ve learned from facilitating a support group,” Taylor said. “Even though physical therapy and speech therapy services may end, patients can still make progress on their own. Joining a support group is a great way for stroke patients to share resources that they find helpful. Survivors can hear each other’s experiences in navigating day-to-day life and the healthcare system after stroke. Caregivers can attend our group, also, and learn ways to help their loved one as well as care for themselves.
“The positivity and encouragement that I witness stroke patients and caregivers have for each other during support group is incomparable.”
Preventing a Second Stroke
After stroke recovery, patients need to work to prevent subsequent strokes.
Katherine Kiehle, stroke navigator and nurse and performance improvement coordinator at Highland Hospital, said that in general, patients who have a stroke are more likely to have another one.
“They need to be more aware of BEFAST and what to do afterwards and engage before they have another,” she said. “They can reduce risk. And if they have another, seek rapid assistance.”
BEFAST stands for balance changes, eyes—vision changes, face asymmetry, arm weakness—numbness, speech slurred, and time (promptly call 911).
Angelina Wronski, registered nurse and stroke coordinator and educator for Unity Hospital recommended quitting smoking and drinking, monitoring blood pressure and cholesterol and watching sugar intake.
In addition, “women have hormonal changes and because of changing estrogen and pregnancy to increase risk. They’re now finding that women are more sensitive to high blood pressure which puts them at greater risk at a lower threshold.”
Nurse Alice Taylor, quality assurance stroke—sepsis—STEMI coordinator for Thompson Health Taylor added that healthful lifestyle modifications, including eating a Mediterranean diet, may lower subsequent stroke risk, along with following provider recommendations for this and other health conditions.
May is National Stroke Awareness Month (or American Stroke Month), dedicated to increasing awareness about stroke prevention, symptoms, and treatment. Roughly 80% of strokes are preventable through healthy lifestyle changes, and knowing the F.A.S.T. warning signs — face drooping, arm weakness, speech difficulty, time to call 911 — can save lives.
Key highlights regarding Stroke Awareness Month:
• Purpose: To educate the public that stroke is largely preventable, treatable, and beatable.
• Actionable Warning Signs (FAST or the new term, BE FAST):
• Prevention: Key factors include monitoring blood pressure, eating well, staying active, and controlling diabetes.
• Key Stats: Stroke is the fifth leading cause of death in the U.S., with over 795,000 people experiencing one annually.
Source: www.stroke.org